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One of my biggest issues is health care. Did you know that in today's insurance world a child with a diagnosis of a developmental disorder such as autism can legally be denied health insurance in the State of Illinois where I live? The same is true for many pre-existing medical conditions and this applys not only to private insurance but employer sponsored plans as well. This means that if my husband ever changes jobs my son, who has an unspecified developmental delay, can be left without health coverage for his regular well child visits and immunizations - not to mentions the two sessions per week of occupational and physical therapy that insurance currently covers. But we consider ourselves extremely fortunate when compared to my sister who, along with my brother-in-law, is self-employed. They pay for private insurance for themselves and their two young children. Because the premiums are so expensive she can only afford to carry catastrophic insurance on herself and her husband which means she does not get regular check-ups or preventative care. Next year she will turn 40 and I know she won't be able to afford mammograms , despite the fact that our grandmother died from the disease. Even with my "fabulous" insurance, I spend a significant portion of my time dealing with the insurance companies repeated attempts to deny claims for my son's medical needs. About every six months they send a notice asking us to confirm that we have no other benefits. If we fail to return this form they stop paying for anything until they get it. It's just a convenient way to hold off on paying bills. Last year we were slapped with $10,000 in hospital bills because our pediatrician used the wrong billing codes for my son's treatment, even after their customer service representative pre-authorized the treatment. I spent an entire year fighting this out with the insurer and the hospital, finally ending up owing nothing and receiving a check for $29.00 from the hospital. I wish they could also reimburse me for my time! My point is that insurance should not be this complicated. Insurers should not employ more people to work on denying claims than they do people to provide helpful service. Doctors should not have to employ an army of billing clerks to deal with insurance company paperwork and some should not have to stop taking it entirely to serve only clients who can afford their service without insurance. There has to be a better way - but I don't believe either of the candidates have a real plan to make insurance simple, affordable and accessible for all children in America. They may provide access for some who do not currently have it - which is a good start - but what I think they really need to look at is the amount of time average Americans and doctors practices in this country are spending dealing with insurance company run arounds. And they need to make it illegal to deny coverage to children (or anyone for that matter) with pre-existing conditions who can afford to pay. That is simply wrong.
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11/07/08 13:34pm PST westtexas8
There is a movement here in Texas where the doctors decided to open their own hospital. I had occation to use one in the city as I had the option of choice because my doctor had privigeles in both a profit corporate hospital and this new one. I was driving 70 miles to use this doc so I went with the doctor run hospital. It was a little plain, the staff was great, and the care was excellent. Can this be a solution- to empower the physicians so that the insurance companies do not have so much power? BTW, I was married to a man who did not survive cancer - threre months after he passed away I was still trying to get physicians paid but, even in the late 90's the chemo alone was 20k a month. They paid as I was persistant and they should have. Still, that is a lot of money. I got the insuracne company's point but hey, they offered the coverage and the company paid through the nose for it.I agree no child should ever be denied insurance, ever. My own daughter has no coverage so her son can have insurance. This is hard to find something that works.




Stumble It!
I completely agree. My mother had to go before a national board of physicians just to get the insurance to cover my treatment for an eating disorder, because they didn't classify it a mental health issue and so they wouldn't pay for any continuing treatment beyond gaining weight. Horrendous! I'm glad there seem to be movements from inside the medical community to correct this.